Somalia has four physiotherapists for 15 million people. Meet one of them.
Somali physical therapist is helping hundreds of children overcome a congenital cause of disability.
More than one million children currently live with untreated clubfoot, and 1.5 billion people worldwide live in conflict-affected areas like Somalia where civil war and unrest have long weakened the country’s health infrastructure. It is difficult for millions of Somalians to access essential health services, and the country’s most vulnerable citizens have limited access to medical care of any kind.
Working at the Somali Red Crescent Society (SRCS) in Mogadishu, Osman Ibrahim Mohamed is one of only four physiotherapists in the entire country. A physical therapist by training, he has lived in Somalia his whole life. He knows too well the plagues of war, famine, and instability, and he has seen firsthand how those with physical disabilities, like untreated clubfoot, are disproportionately affected.
Osman first became interested in clubfoot treatment over 20 years ago when writing his thesis on the condition. He learned that the Ponseti Method is ideal for a country like Somalia, where resources are scarce and healthcare workers are in short supply; the treatment requires only simple materials, is much less invasive and less expensive than surgery, and has a higher success rate.
After working for the SRCS for many years, Osman began contemplating his legacy. “I said to myself, ‘Osman, it’s time that you help the Somali children. Help them get the right treatment,’” he recounts.
The need to help those living with this common birth defect was obvious. The problem was finding an international partner who could help. With Somalia’s Ministry of Health hampered by security concerns, Osman needed a partner who could provide technical and financial assistance to get the program off the ground. In 2019 a partnership between MiracleFeet, the Somali Red Crescent Society, and International Committee of the Red Cross was finalized. In March of 2019, three clinics in Somalia launched Ponseti programs.
The response has been overwhelming, with families coming from as far as 500 km away to enroll their children in treatment. Using only word-of-mouth and without any advertising or outreach, the clinic in Mogadishu already has a long waiting list—evidence of how vital these services are and indicative of the enormous need. Approximately 800 children are born with clubfoot each year in Somalia alone. In 221, SRCS treated approximately 300.
And, of course, the pandemic has made accessing care even more difficult. The SRCS clinic temporarily closed in May of 2020 when COVID cases were high in Mogadishu. It has since reopened with safety protocols in place such as mask wearing, physical distancing when possible, and decreased appointment volumes. With so many children in the middle of treatment and many more waiting, Osman and his team felt the need to reopen was essential. In fact, Osman has steadily grown the clinic during COVID recovering over 70% of patients whose care was affected. On top of that, Somalia’s treatment quality is high, hitting all the “gold standard” targets for quality indicators.
For Osman, one of the most satisfying parts of his work is knowing that he is making a difference for children whose families did not believe they would ever walk on the soles of their feet, without pain. He describes the story of one child who came to the clinic: the father spent a year saving for his son’s surgery, but even after the costly surgery and five months of casts, his clubfoot had not improved. The father was reluctant to enroll his son in yet another treatment, but then overjoyed to see progress after just three properly applied casts. He began crying, asking “Why didn’t I come here first?”
There is an overwhelming need for more rehabilitative professionals.
Osman is one of two physical therapists in his region, which serves approximately six million people. There are only four physical therapists and five physiotherapy assistants in the entire country. There are no occupational therapists, speech therapists, or social workers.
The need is so much more than the capacity, but Osman is dedicated to doing his part. As a certified Ponseti trainer, he regularly travels to other clinics in Somalia to train providers in the method. The opportunity to build the capacity of other health professionals in Somalia is essential to reaching all those who need care.
“Ponseti is a step forward,” he explains. “You can see the results after only three or four casts. In every part of Somalia, people need this program.” Eventually, with more trained providers, the program will be equipped to open additional clinics meaning families can find treatment closer to home, sparing them expensive and dangerous travel. In the interim, a pilot program is providing parents and children traveling long distances accommodation near the clinic.
Increasing the number of clinics with trained providers who can deliver quality care is key to reaching children with untreated clubfoot globally, and none of that can happen without compassionate leaders like Osman.
“Ponseti is a step forward. In every part of Somalia, people need this program.”